Ankle Flashcards
What does Simmonds test
Achilles tear/rupture
Simmonds technique
Pt prone
Feet off couch
Squeeze calves
+ve Simmonds
No plantar flexion
What does talar tilt test
Inversion- lateral sprain (ant/post talofibular ligament, calcaneofibular lig, post talofibular lig)
Eversion- medial sprain (deltoid lig)
Talar tilt technique
Pt seated or supine
Place pillow under knee
Hand placement on lat + med malleoli
Invert foot & plantar flex is ant talofibular
Evert foot
Neutral calcanofibular
Full Doris flex post talofibular
+ve Talar tilt
Inversion- lateral sprain/rupture= P + increased motion
Eversion- med sprain= P + increased motion
Specificity of Talar tilt
75
Sensitivity of Talar tilt
67
What does ant/post drawer test
Ant talofibular ligament instability
Post ankle ligament instability
Ant/post drawer technique
Pt supine
Bend leg, foot on couch
Fix top of foot
Support round back of Achilles, pull forward post
Ant- push shin
+ve Ant/post drawer
Increased ant movement (ATFL)
Increased post movement (PTFL)
Ant/post drawer clinical notes
Compare bilaterally
In normal individuals test should produce little to no motion
What does Tinel’s sign test
Tarsal tunnel syndrome (post tibial nerve)
Tinels sign technique
Pt supine with hip of affected side ER + foot slightly everted
Tap behind medial malleolus- post tibial nerve/medial plantar nerve
Over the dorsum of the ankle near the neck of talus- deep peroneal
+ve Tinels foot
Radiating P in foot + toes due to aggravation of tibial N (heel)
What does Homans sign test
Thrombosis
Strain
Achilles rupture
Homans technqiue
Pt supine with leg straight
Raise leg to 10 deg
Forcefully dorsiflex foot + squeeze calf with other hand
+ve Homans
Deep P in calf- thrombosis
Local- gastrocs/soleus strain
No PF with squeeze- complete achilles rupture
Specificity of Homans
41
Sensitivity of Homans
35-48
Achilles tap test procedure
Pt supine, seated or prone
Tap over achilles with fingers or reflex hammer
Observe for PF
Achilles tap test interpretation
P or lack of PF= achilles tendonitis, achilles tendon rupture
Buergers test
Pt supine
Leg straight at 45
Hold for 3 mins
Lower leg, below table, instruct Pt to sit up
Observe refilling of dorsal veins of foot
Buergers interpretation
> 1-2 mins required for cyanosis (red) + refilling of dorsal veins of foot to occur = lower ex vascular compromise (PVD, atherosclerosis)
Calcaenus squeeze test
Pt prone
Flex knee to 90
Squeeze in three locations
1. side
2. calcaneal tuberosity (post calcaneus)
3. medial calcaneal tubercle
Observe for P or discomfort
Calcaneal squeeze test interpretation
P with
1. side- #
2. calcaneal tuberosity- retrocalcaneal bursitis, #
3. medial- plantar fasciitis
Fibular translation test
Pt side lying
Examiner stabilises medial malleolus (cupping) + applies anterior + posterior force over lateral malleolus
Fibular translation interpretation
P or discomfort of fibula- tear of syndesmosis ligaments
Fib translation sens
82
Fib translation spec
88
Mortons procedure
Pt supine or seated
Examiner squeezes foot around metatarsal heads
Observe for P/discomfort
Mortons interpretation
P- mortons neuroma, metatarsal Jt arthritis, # of metatarsal heads
Mortons clinical notes
Usually between distal metatarsals
Between 3-4 55%, 2-3 45%
Mortons DDx
Metatarsalgia P less localised with P under metatarsal heads (parasthesia not present)
Stress # P localised to metatarsal shaft- not between metatarsals (palpate directly)
Deep peroneal neuropathy- S+S between 1+2 toes
Subtalar glide
Pt supine
Stabilise talus and apply a medial then lateral force to the calcaneus
Subtalar glide interpretation
P or displacement calcaneus= subtalar sprain or instability
Subtalar spec
75
Subtalar sens
78
Subtalar glide clinical notes
Should be minimal movement
Windlass procedure
Pt seated
Examiner stabilises ankle in neutral + extends big toe while allowing the IP Jt to flex
Repeat with Pt standing
Windlass interpretation
P or symptom reproduction- plantar fasciitis
Windlass clinical notes
May extend all toes
Windlass effect is primary mechanism that lifts the medial longitudinal arch during toe off
